Provider Demographics
NPI:1891751921
Name:LOPEZ, REBECCA E (LMSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:E
Last Name:LOPEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4123 OKEMOS RD STE 15
Mailing Address - Street 2:
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-2818
Mailing Address - Country:US
Mailing Address - Phone:517-243-9738
Mailing Address - Fax:
Practice Address - Street 1:4123 OKEMOS RD
Practice Address - Street 2:STE 15
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-2818
Practice Address - Country:US
Practice Address - Phone:989-224-6729
Practice Address - Fax:989-224-2342
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802083283104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C36171129Medicare PIN